Uncontrolled Blood Pressure in the Young

I am in Ghana during February with fellow medical students, volunteering and learning at the IHDN Mission Hospital.  As a final year medical student, I am focusing on clinic work rather than research this trip, but we had a patient that was a stark reminder of how we need to continue to raise awareness in Ghana about elevated blood pressures.  

The day was nearing completion and most of the consultation rooms had wrapped up their days work.  Sarah was the lone provider when a patient walked through the door.  He was a young man and his eye were open as wide as possible, as if he was in a dark room searching for light.  Quickly, Sarah and a nurse ushered him and his escort to the screening room where they found his blood pressure to be 236/150.  Dr. Agamah was immediately sent for and evaluation and treatment were commenced.  Fortunately, we had brought IV medications to treat hypertensive emergencies and were able to effectively lower his blood pressure.  Just last month, before we arrived, the only option would have been an oral antihypertensive which would have taken much longer to act. 

This previously healthy 31 year old gentleman had been living in Accra, the capital city, and traveled over 3 hours to reach the IHDN hospital which was near his home village.  He had been experiencing severe headache for almost 2 weeks when his world suddenly went dark.  On exam he was found to have bilateral retinal hemorrhages that resulted in near total blindness.  Fortunately, after 2 days of treatment the hemorrhage began to resolve and he was able to be discharged from the hospital with a controlled blood pressure and improving vision.

This case is a striking reminder that hypertension is prevalent in Ghana and needs to be aggressively screened for, even in the young.


(Patient and blood pressure after 2 doses of IV Labetolol)

In addition to clinic work, we have been able to host two blood pressure screening events.  The first was held after a church service down the road from where we stay in Agbozume.  The goal is to have similar screenings on a monthly basis so that the entire congregation can be screened.  The second screening event was held at the village of Worgbato which is far off of the main road.  This was going to be the original site for the IHDN Mission Clinic before Dr. Agamah realized how great the need was in the whole area and a larger site had to be chosen.  IHDN hopes to establish a satellite clinic in the village in the future.  We are planning subsequent screenings in the market in the coming days. 

             Ghana 2014 352Ghana 2014 099


AAFP Global Health Workshop 2013

Are they getting the message? Health modification suggestions for hypertensive patients in rural Southeastern Ghana

Benjamin Henkle, MS IV, MPH1, Sarah Henkle, MS IV, BA, BS2, Mark Dedzoe, MBA3, Edem Agamah, MD1,3

1SIU School of Medicine, 2Rush Medical College, 3International Health & Development Network

Reported rates of hypertension (HTN) in Ghana have drastically increased over the past 35 years. In this cross-sectional study of the Volta Region, prevalence of HTN and healthcare provider health modification messages for hypertensive patients were assessed. At community-based screening events, blood pressures were measured and questionnaires administered assessing physician recommendations to decrease salt intake (DS), eat more healthfully (EH), lose weight (LW), and increase physical activity (IA). Statistical analysis revealed 36% prevalence of HTN among 1025 subjects with just 17% controlled. Odds of receiving health modification messages were significantly associated with being hypertensive (OR [95% CI]: DS=2.4 [1.8-3.2]; EH=1.8 [1.4-2.3]; LW=2.3 [1.6-3.4]; IA=2.0 [1.4-2.8]) and being aware of one’s HTN (OR [95% CI]: DS=5.5 [3.5-8.8]; EH=4.6 [3.0-7.1]; LW=3.8 [2.2-6.8]; IA=2.7 [1.7-4.4]), while the odds of achieving control were associated with more recent contact with a healthcare provider (OR 3.92 [1.92-7.980]). Therefore, while appropriate health modification messages and treatment are provided with a diagnosis of HTN, new efforts are needed to improve implementation and encourage follow-up with healthcare providers.


Prospective Urban Rural Epidemiology (PURE) Study

The September 4th, 2013 volume of JAMA featured an article that is right inline with the efforts we are making to study hypertension in Ghana.  The Prospective Urban Rural Epidemiology (PURE) study is a cross-sectional study involving urban and rural communities from 17 countries.  Low income countries included in the study were Bangladesh, India, Pakistan, and Zimbabwe.


In the low income countries the prevalence of HTN was 44.4% in urban areas and 31.5% in rural areas.  Awareness was 48.4% in urban areas and 31.2 in rural areas while control was dismal at 12.8% in urban areas and 6.9% in rural areas.  These numbers are similar to what we have seen in SE Ghana.  We have found a prevalence of 36%, awareness of 46% but only 17% control.   

With every study it become increasingly evident that HTN is prevalent throughout the world and is especially present in the rural areas of low income countries.  Current treatment strategies are clearly inadequate to combat HTN in resource poor countries. 


Self Reported Hypertension in the US

This weeks MMWR reported on self-reported hypertension and use of antihypertensive medications among US adults between 2005 and 2009.  Using data collected from the national BRFSS telephone survey, it was identified that there was a small but significant increase in self-reported hypertension in the US.  As the article mentions, this is likely a reflection of increased awareness, a good thing, and not an increase in true prevalence.  Further, there was a small increase in the use of antihypertensive medication among adults reporting hypertension.  Most interesting is the variability in hypertension and medication use across the country. 

It makes me wonder, if this map was of Ghana, how would it look?  What areas would have the highest rates?  The coastal areas? The urbanized regions?  Based on the limited data that is available, I think that hypertension would be prevalent through out the country.  We have shown that it is surprisingly prevalent (36%) in southeastern Ghana and studies from the Ashanti region report a prevalence of 28-29%.  

The figure shows age-adjusted prevalence of self-reported hypertension among adults and the proportion of those participants reporting use of antihypertensive medication during 2009, by state, according to the Behavioral Risk Factor Surveillance System. In 2009, the prevalence of self-reported hypertension was, in general, higher in southern states and lower in western states.


December Newsletter

Better late then never I suppose. December 2012 IHDN Newsletter


Physician Health Messages on Hypertension

Back in May I presented some of our data at the SIU School of Medicine’s 22nd Annual Trainee Research Symposium. In this analysis, we looked at the health messages on hypertension that the people in southeastern Ghana were given by health care personnel. We were happy to find that when a person is diagnosed with hypertension they are receiving health modification messages such as reducing salt intake, increasing activity, losing weight, and eating more healthfully. Unfortunately, control of hypertension is still very poor, with only 17% of people with known hypertension being controlled to an appropriate level.

In resource poor regions, like Ghana, non-pharmaceutical interventions are an even more important component of health care. This data shows that we need to develop more effective health messages that, when combined with medications, can better reduce the burden of hypertension.

For more information on this analysis see the associated abstract and poster here.


Hospital Construction Continues

The latest IHDN building project, an 80+ bed inpatient unit, is progressing nicely.  It is a much needed addition to the IHDN Mission Hospital as it continues to grow as a regional health care provider.